Logical model representing the data elements of Frame B (Other Medical Data) of the WHO Medical Certificate of Cause of Death (MCCoD).

Frame B is OPTIONAL at the section level. However, certain sub-sections SHOULD be populated based on the clinical context of the death:

• The Fetal or Infant Death sub-section SHOULD be populated when the deceased was an infant or newborn (age at death less than 28 days), or when the death was a stillbirth.
• The Women of Reproductive Age sub-section SHOULD be populated when the deceased was female and aged 15–49 years at time of death.
• External cause elements SHOULD be populated when manner of death is Assault, Accident, Legal Intervention, Intentional Self Harm, or War.

These conditional requirements are enforced as warning-level invariants in the MCCoDComposition profile, not as hard errors, consistent with the optional nature of Frame B.

This model is derived from:

• WHO International Form of Medical Certificate of Cause of Death
• openEHR-EHR-EVALUATION.death_summary.v0 (CKM archetype)
• WHO SMART Guidelines L2 DAK data dictionary pattern

General medical data about the circumstances of death including surgery, autopsy, manner of death, and external cause details. This sub-section is optional but SHOULD be populated when any of its elements are known.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Documents whether surgery was performed within the 4 weeks preceding death. Relevant for determining whether surgery may have contributed to the cause of death.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Whether surgery was performed within the last 4 weeks before death. Coded as: yes | no | unknown

Date surgery was performed. Required when wasPerformed is 'yes'.

Disease or condition for which surgery was performed. Required when wasPerformed is 'yes'. Free text as written by certifying practitioner.

Documents whether an autopsy was requested and whether findings were used in the certification of cause of death.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Whether an autopsy was requested. Coded as: yes | no | unknown

Whether autopsy findings were used in the certification of the cause of death. Applicable only when wasRequested is 'yes'. Coded as: yes | no | unknown

The manner in which the death occurred. Drawn from the mccod-manner-of-death-codes ValueSet.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Coded manner of death from mccod-manner-of-death-codes ValueSet. Required binding: Disease | Assault | Accident | Legal Intervention | Could Not Be Determined | Pending Investigation | Intentional Self Harm | War | Unknown

Details of the external cause of death or poisoning. SHOULD be populated when manner of death is one of: Assault, Accident, Legal Intervention, Intentional Self Harm, War. This conditional requirement is enforced as a warning-level invariant in MCCoDComposition.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Free-text description of how the external cause occurred. If poisoning, the poisoning agent SHALL be specified here.

Date on which the external cause (injury or poisoning) occurred.

Place where the external cause occurred. Required binding to mccod-place-of-injury-codes ValueSet. When coded as 'other', a text description SHALL be provided.

Data elements specific to fetal or infant deaths.

CONDITIONAL GUIDANCE: This sub-section SHOULD be populated when:

• The deceased was an infant aged less than 28 days at death, OR
• The death was recorded as a stillbirth This is enforced as a warning-level invariant in MCCoDComposition using Patient.birthDate compared to Composition.date.

When this section is intentionally omitted for a non-infant death, the Composition.section[frameBFetalInfant].emptyReason SHALL be provided.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Whether the death occurred in the context of a multiple pregnancy. Coded as: yes | no | unknown

Whether the death was a stillbirth (fetal death after 28 weeks of gestation with no signs of life after delivery). Coded as: yes | no | unknown

Number of hours the infant survived if death occurred within 24 hours of birth. Applicable only when stillborn is 'no'.

Birth weight of the infant or fetus in grams.

Gestational age at birth expressed as completed weeks of pregnancy.

Age of the mother at the time of birth/delivery, in years.

Conditions of the mother that affected the fetus or newborn, relevant to a perinatal death. Free text as written by the certifying practitioner.

Data elements specific to deaths of women of reproductive age (15–49).

CONDITIONAL GUIDANCE: This sub-section SHOULD be populated when:

• The deceased was recorded as female, AND
• Age at death was between 15 and 49 years (inclusive) This is enforced as a warning-level invariant in MCCoDComposition using Patient.gender and calculated age at death.

When this section is intentionally omitted for a male deceased or a female outside reproductive age, the Composition.section[frameBPregnancy].emptyReason SHALL be provided.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Whether the deceased was pregnant at any point during the year preceding death. This is the outer gating question for this section. Coded as: yes | no | unknown Cardinality 1..1 within the womenOfReproductiveAge backbone — if this backbone is present, this question SHALL be answered.

The timing of the pregnancy relative to the time of death. Applicable only when pregnantWithinPastYear is 'yes'. Required binding to mccod-pregnancy-status-codes ValueSet:

• When she died
• Within the 42 days preceding her death
• Within 43 days up to 1 year preceding her death
• Exact pregnancy timing unknown

Whether the pregnancy contributed to the death of the woman. Applicable only when pregnantWithinPastYear is 'yes'. Coded as: yes | no | unknown

Logical model representing the data elements of Frame B (Other Medical Data) of the WHO Medical Certificate of Cause of Death (MCCoD).

Frame B is OPTIONAL at the section level. However, certain sub-sections SHOULD be populated based on the clinical context of the death:

• The Fetal or Infant Death sub-section SHOULD be populated when the deceased was an infant or newborn (age at death less than 28 days), or when the death was a stillbirth.
• The Women of Reproductive Age sub-section SHOULD be populated when the deceased was female and aged 15–49 years at time of death.
• External cause elements SHOULD be populated when manner of death is Assault, Accident, Legal Intervention, Intentional Self Harm, or War.

These conditional requirements are enforced as warning-level invariants in the MCCoDComposition profile, not as hard errors, consistent with the optional nature of Frame B.

This model is derived from:

• WHO International Form of Medical Certificate of Cause of Death
• openEHR-EHR-EVALUATION.death_summary.v0 (CKM archetype)
• WHO SMART Guidelines L2 DAK data dictionary pattern

General medical data about the circumstances of death including surgery, autopsy, manner of death, and external cause details. This sub-section is optional but SHOULD be populated when any of its elements are known.

Documents whether surgery was performed within the 4 weeks preceding death. Relevant for determining whether surgery may have contributed to the cause of death.

Whether surgery was performed within the last 4 weeks before death. Coded as: yes | no | unknown

Date surgery was performed. Required when wasPerformed is 'yes'.

Disease or condition for which surgery was performed. Required when wasPerformed is 'yes'. Free text as written by certifying practitioner.

Documents whether an autopsy was requested and whether findings were used in the certification of cause of death.

Whether an autopsy was requested. Coded as: yes | no | unknown

Whether autopsy findings were used in the certification of the cause of death. Applicable only when wasRequested is 'yes'. Coded as: yes | no | unknown

The manner in which the death occurred. Drawn from the mccod-manner-of-death-codes ValueSet.

Coded manner of death from mccod-manner-of-death-codes ValueSet. Required binding: Disease | Assault | Accident | Legal Intervention | Could Not Be Determined | Pending Investigation | Intentional Self Harm | War | Unknown

Details of the external cause of death or poisoning. SHOULD be populated when manner of death is one of: Assault, Accident, Legal Intervention, Intentional Self Harm, War. This conditional requirement is enforced as a warning-level invariant in MCCoDComposition.

Free-text description of how the external cause occurred. If poisoning, the poisoning agent SHALL be specified here.

Date on which the external cause (injury or poisoning) occurred.

Place where the external cause occurred. Required binding to mccod-place-of-injury-codes ValueSet. When coded as 'other', a text description SHALL be provided.

Data elements specific to fetal or infant deaths.

CONDITIONAL GUIDANCE: This sub-section SHOULD be populated when:

• The deceased was an infant aged less than 28 days at death, OR
• The death was recorded as a stillbirth This is enforced as a warning-level invariant in MCCoDComposition using Patient.birthDate compared to Composition.date.

When this section is intentionally omitted for a non-infant death, the Composition.section[frameBFetalInfant].emptyReason SHALL be provided.

Whether the death occurred in the context of a multiple pregnancy. Coded as: yes | no | unknown

Whether the death was a stillbirth (fetal death after 28 weeks of gestation with no signs of life after delivery). Coded as: yes | no | unknown

Number of hours the infant survived if death occurred within 24 hours of birth. Applicable only when stillborn is 'no'.

Birth weight of the infant or fetus in grams.

Gestational age at birth expressed as completed weeks of pregnancy.

Age of the mother at the time of birth/delivery, in years.

Conditions of the mother that affected the fetus or newborn, relevant to a perinatal death. Free text as written by the certifying practitioner.

Data elements specific to deaths of women of reproductive age (15–49).

CONDITIONAL GUIDANCE: This sub-section SHOULD be populated when:

• The deceased was recorded as female, AND
• Age at death was between 15 and 49 years (inclusive) This is enforced as a warning-level invariant in MCCoDComposition using Patient.gender and calculated age at death.

When this section is intentionally omitted for a male deceased or a female outside reproductive age, the Composition.section[frameBPregnancy].emptyReason SHALL be provided.

Whether the deceased was pregnant at any point during the year preceding death. This is the outer gating question for this section. Coded as: yes | no | unknown Cardinality 1..1 within the womenOfReproductiveAge backbone — if this backbone is present, this question SHALL be answered.

The timing of the pregnancy relative to the time of death. Applicable only when pregnantWithinPastYear is 'yes'. Required binding to mccod-pregnancy-status-codes ValueSet:

• When she died
• Within the 42 days preceding her death
• Within 43 days up to 1 year preceding her death
• Exact pregnancy timing unknown

Whether the pregnancy contributed to the death of the woman. Applicable only when pregnantWithinPastYear is 'yes'. Coded as: yes | no | unknown

Logical model representing the data elements of Frame B (Other Medical Data) of the WHO Medical Certificate of Cause of Death (MCCoD).

Frame B is OPTIONAL at the section level. However, certain sub-sections SHOULD be populated based on the clinical context of the death:

• The Fetal or Infant Death sub-section SHOULD be populated when the deceased was an infant or newborn (age at death less than 28 days), or when the death was a stillbirth.
• The Women of Reproductive Age sub-section SHOULD be populated when the deceased was female and aged 15–49 years at time of death.
• External cause elements SHOULD be populated when manner of death is Assault, Accident, Legal Intervention, Intentional Self Harm, or War.

These conditional requirements are enforced as warning-level invariants in the MCCoDComposition profile, not as hard errors, consistent with the optional nature of Frame B.

This model is derived from:

• WHO International Form of Medical Certificate of Cause of Death
• openEHR-EHR-EVALUATION.death_summary.v0 (CKM archetype)
• WHO SMART Guidelines L2 DAK data dictionary pattern

General medical data about the circumstances of death including surgery, autopsy, manner of death, and external cause details. This sub-section is optional but SHOULD be populated when any of its elements are known.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Documents whether surgery was performed within the 4 weeks preceding death. Relevant for determining whether surgery may have contributed to the cause of death.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Whether surgery was performed within the last 4 weeks before death. Coded as: yes | no | unknown

Date surgery was performed. Required when wasPerformed is 'yes'.

Disease or condition for which surgery was performed. Required when wasPerformed is 'yes'. Free text as written by certifying practitioner.

Documents whether an autopsy was requested and whether findings were used in the certification of cause of death.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Whether an autopsy was requested. Coded as: yes | no | unknown

Whether autopsy findings were used in the certification of the cause of death. Applicable only when wasRequested is 'yes'. Coded as: yes | no | unknown

The manner in which the death occurred. Drawn from the mccod-manner-of-death-codes ValueSet.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Coded manner of death from mccod-manner-of-death-codes ValueSet. Required binding: Disease | Assault | Accident | Legal Intervention | Could Not Be Determined | Pending Investigation | Intentional Self Harm | War | Unknown

Details of the external cause of death or poisoning. SHOULD be populated when manner of death is one of: Assault, Accident, Legal Intervention, Intentional Self Harm, War. This conditional requirement is enforced as a warning-level invariant in MCCoDComposition.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Free-text description of how the external cause occurred. If poisoning, the poisoning agent SHALL be specified here.

Date on which the external cause (injury or poisoning) occurred.

Place where the external cause occurred. Required binding to mccod-place-of-injury-codes ValueSet. When coded as 'other', a text description SHALL be provided.

Data elements specific to fetal or infant deaths.

CONDITIONAL GUIDANCE: This sub-section SHOULD be populated when:

• The deceased was an infant aged less than 28 days at death, OR
• The death was recorded as a stillbirth This is enforced as a warning-level invariant in MCCoDComposition using Patient.birthDate compared to Composition.date.

When this section is intentionally omitted for a non-infant death, the Composition.section[frameBFetalInfant].emptyReason SHALL be provided.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Whether the death occurred in the context of a multiple pregnancy. Coded as: yes | no | unknown

Whether the death was a stillbirth (fetal death after 28 weeks of gestation with no signs of life after delivery). Coded as: yes | no | unknown

Number of hours the infant survived if death occurred within 24 hours of birth. Applicable only when stillborn is 'no'.

Birth weight of the infant or fetus in grams.

Gestational age at birth expressed as completed weeks of pregnancy.

Age of the mother at the time of birth/delivery, in years.

Conditions of the mother that affected the fetus or newborn, relevant to a perinatal death. Free text as written by the certifying practitioner.

Data elements specific to deaths of women of reproductive age (15–49).

CONDITIONAL GUIDANCE: This sub-section SHOULD be populated when:

• The deceased was recorded as female, AND
• Age at death was between 15 and 49 years (inclusive) This is enforced as a warning-level invariant in MCCoDComposition using Patient.gender and calculated age at death.

When this section is intentionally omitted for a male deceased or a female outside reproductive age, the Composition.section[frameBPregnancy].emptyReason SHALL be provided.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Whether the deceased was pregnant at any point during the year preceding death. This is the outer gating question for this section. Coded as: yes | no | unknown Cardinality 1..1 within the womenOfReproductiveAge backbone — if this backbone is present, this question SHALL be answered.

The timing of the pregnancy relative to the time of death. Applicable only when pregnantWithinPastYear is 'yes'. Required binding to mccod-pregnancy-status-codes ValueSet:

• When she died
• Within the 42 days preceding her death
• Within 43 days up to 1 year preceding her death
• Exact pregnancy timing unknown

Whether the pregnancy contributed to the death of the woman. Applicable only when pregnantWithinPastYear is 'yes'. Coded as: yes | no | unknown